Many people suffer from mood or affective disorders as psychiatrists call them. Those who suffer from depression may have distinct bouts which recur but with periods of normal mood (euthymia) in between. Occasionally they have episodes of elevated mood. When extreme this is called mania, which implies a break from reality in which mood drives delusions and hallucinations – for example, the belief that one is fabulously wealthy, in possession of special powers, a genius or superhero; or hearing heavenly choirs, the music of the spheres or the voice of God. The person with mania has boundless energy and may go without sleep for days on end, eventually grinding to a halt through sheer exhaustion. Speech may be so sped up as to be incomprehensible.
More often the episodes are mild and short-lived: ‘hypomania, a potentially confusing term that just means an elevated mood short of mania. Hypomania is sometimes the result of antidepressant treatment acting on an over-sensitive biological mood-control system. A person with hypomania is also full of energy. Initially it’s infectious, but it soon becomes wearing. Their speech may be fast and furious but you can follow it (barely). They are optimistic without being irrational, but their judgment and priorities are distorted and relationships tend to become strained by the person’s self-absorption and lack of consideration for others.
Oddly, the person with mania and indeed hypomania is rarely happy. Sadness and happiness are normally the poles of a person’s mood. Just as depression takes the person beyond the familiar landscape of sadness into an altogether darker, bleaker place, hypomania and mania go outside the normal bounds of happiness to a place where nothing is constant and change is fast. It is an impatient world where no one suffers fools.
I want it and I want it now, mania seems to say. It’s less like happiness and more like irritability, a poorly understood emotional state at the heart of many interpersonal and psychiatric difficulties.’ The person with hypomania may start out positive and generous – they may give away their money and possessions, and their affections – but they soon feel unsatisfied when the world does not reciprocate. It’s too damn slow; people are idiots! Generosity may lead to penury and new schemes go pear-shaped. All this is frustrating for the person suffering from hypomania, and such frustration can lead to aggression and even violence.
Just as there may be a biological mood-control system that senses chemical disruption – be it antidepressants, alcohol or stimulants – it seems natural to infer a psychological regulator which is always trying to keep our mood within reasonable bounds. Once the mood runs outside the range, it becomes unsta-ble, wobbly or labile. The person with mania can suddenly flip into maudlin despair and then back to ecstasy, leaving bystanders drained and uncomprehending.
Haven’t we all had times when we were on a roll and everything just flowed? Anything we wanted to say came out right; we were witty, clever, erudite. Our movements were fluid and graceful, our senses heightened. People sometimes describe periods of great creativity and energy, possibly balanced by periods in the doldrums when quiet contemplation takes over. The psychiatric term is ‘cyclothymia: If the old trope of madness and creativity has any credence at all, it is probably related to this kind of controlled bipolarity.
Hunger and the drive to eat is one of our most powerful biological drives. However, as with the sexual drive, it is the vast web of culture – made up of ritual, mores, commercialization and ethics – that now governs our eating behavior rather than the simple evolutionary imperatives.
The control of appetite is managed by a complex but beautifully balanced neural-humeral programme. This is part of what physiologists call homeostasis, the ability of the body to control its internal environment so that it always has enough energy. Lack of food prompts the release of hormones (‘humours’) such as cholecystokinin and ghrelin,’ which are orexigenic (orexis is Greek for appetite) – we get hungry and seek food. As that food hits the stomach, it causes the release of hormones such as insulin and leptin, chemical messengers which tell the brain’s engine room, the hypothalamus, to stop eating (anorexigenic) – leading us to feel full.
Not only are there many other hormones running through the bloodstream, there are also electrical messages to be conveyed through the nervous system. The main electrical cable connecting the gut and the brain is the vagus nerve. The stomach sends electrical signals up into the brain to make us hungry or full, as well as triggering reflex behaviours ranging from the basic (e.g. salivation) to the highly complex (book-ing a table at Escoffier’s). A group of cells called ‘agouti-related peptide-expressing neurones’ in the hypothalamus seem to be key to this process.
Brain activity fans out from the hypothalamus – which sits at the top of the brain stem, underneath the thalamus, the brain’s sensory relay station – upwards to regions in the mid-brain underlying motivation and reward, producing in us feelings of liking and desire. From there, the activity continues on to higher executive control regions in the cortex where we can mull over such sensations (i.e. plan when to repeat them, or feel guilty and contemplate going on a diet).
When it comes to food, how soon homeostasis and physiological balance slips into notions of moral balance. Take this process and throw it into the real world and you can end up with a standoff: homeostatic eating versus hedonic eating (eating for pleasure).
It is not difficult to see how low mood dulls all pleasurable feelings; that’s why a core symptom of depression is anhedonia (literally lack of pleasure). It’s less common, but some people find that low mood leads to ‘comfort eating, in which the aim may be to chase the vanishing opportunities for pleasurable sensations, but the result is usually more despair and self-loathing.
As we move from the body as directly controlled and perceived, to the body as more vaguely felt and into the body as imagined, we move from the tangibility of the physical world through psychology into the changeable and sometimes harsh realities of the social world. Each map or image becomes increasingly less literal as it passes from the somatosensory cortex to areas of the brain like the temporal and frontal lobes, where information to and from the body is not simply relayed but also manipulated and abstracted.
Source : Into the Abyss: A Neuropsychiatrist’s Notes on Troubled Minds by Anthony David
Goodreads : https://www.goodreads.com/book/show/52386552-into-the-abyss
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